中国医药
中國醫藥
중국의약
CHINA MEDICINE
2012年
6期
696-698
,共3页
蛛网膜下腔出血,创伤性%尼莫地平%血管痉挛,颅内%术中灌洗
蛛網膜下腔齣血,創傷性%尼莫地平%血管痙攣,顱內%術中灌洗
주망막하강출혈,창상성%니막지평%혈관경련,로내%술중관세
Subarachnoid hemorrhage,traumatic%Nimodipine%Vasospasm,intracranial%Perfusion in operation
目的 评价外伤性蛛网膜下腔出血(t-SAH)或鼻饲早期通过不同给药途径应用尼莫地平治疗的效果.方法 将80例t-SAH患者随机分为4组,即对照组、口服或鼻饲给药组、静脉给药组、术野灌洗+静脉给药组,每组20例.动态观察伤后格拉斯哥昏迷评分(GCS)变化,监测颅内压,应用经颅多普勒检测伤侧大脑中动脉(MCA)收缩峰流速(Vp)变化,伤后3个月随访记录格拉斯哥预后评分(GOS).结果 术野灌洗+静脉给药组脑血管痉挛发生率和3个月后预后不良率[分别为25.0％ (5/20)比70.0％ (14/20)、55.0％ (11/20)、35.0％ (7/20)和30.0％ (6/20)比50.0％(10/20)、40.0％ (8/20)、35.0％ (7/20)]明显低于对照组、口服或鼻饲给药组、静脉给药组,差异均有统计学意义(均P＜0.05).术野灌洗+静脉给药组、静脉给药、口服或鼻饲给药组、对照组患者手术后1周、2周、3周Vp均较手术前低(均P＜0.05)；4组患者术后1周内颅内压变化均随水肿高峰期的变化呈现先升高后下降的趋势；术后4组患者GCS变化均呈上升趋势,手术后第21天,4组患者GCS评分均较手术后第1天明显升高,差异有统计学意义(均P＜0.05).术野灌洗+静脉给药组预后不良患者比例明显低于对照组和口服或鼻饲给药组[30.0％(6/20)比50.0％ (10/20)、40.0％ (8/20),P＜0.05].结论 在颅脑创伤早期采用静脉给药联合术野灌洗的方式使用尼莫地平治疗t-SAH可以减少脑血管痉挛的发生.
目的 評價外傷性蛛網膜下腔齣血(t-SAH)或鼻飼早期通過不同給藥途徑應用尼莫地平治療的效果.方法 將80例t-SAH患者隨機分為4組,即對照組、口服或鼻飼給藥組、靜脈給藥組、術野灌洗+靜脈給藥組,每組20例.動態觀察傷後格拉斯哥昏迷評分(GCS)變化,鑑測顱內壓,應用經顱多普勒檢測傷側大腦中動脈(MCA)收縮峰流速(Vp)變化,傷後3箇月隨訪記錄格拉斯哥預後評分(GOS).結果 術野灌洗+靜脈給藥組腦血管痙攣髮生率和3箇月後預後不良率[分彆為25.0％ (5/20)比70.0％ (14/20)、55.0％ (11/20)、35.0％ (7/20)和30.0％ (6/20)比50.0％(10/20)、40.0％ (8/20)、35.0％ (7/20)]明顯低于對照組、口服或鼻飼給藥組、靜脈給藥組,差異均有統計學意義(均P＜0.05).術野灌洗+靜脈給藥組、靜脈給藥、口服或鼻飼給藥組、對照組患者手術後1週、2週、3週Vp均較手術前低(均P＜0.05)；4組患者術後1週內顱內壓變化均隨水腫高峰期的變化呈現先升高後下降的趨勢；術後4組患者GCS變化均呈上升趨勢,手術後第21天,4組患者GCS評分均較手術後第1天明顯升高,差異有統計學意義(均P＜0.05).術野灌洗+靜脈給藥組預後不良患者比例明顯低于對照組和口服或鼻飼給藥組[30.0％(6/20)比50.0％ (10/20)、40.0％ (8/20),P＜0.05].結論 在顱腦創傷早期採用靜脈給藥聯閤術野灌洗的方式使用尼莫地平治療t-SAH可以減少腦血管痙攣的髮生.
목적 평개외상성주망막하강출혈(t-SAH)혹비사조기통과불동급약도경응용니막지평치료적효과.방법 장80례t-SAH환자수궤분위4조,즉대조조、구복혹비사급약조、정맥급약조、술야관세+정맥급약조,매조20례.동태관찰상후격랍사가혼미평분(GCS)변화,감측로내압,응용경로다보륵검측상측대뇌중동맥(MCA)수축봉류속(Vp)변화,상후3개월수방기록격랍사가예후평분(GOS).결과 술야관세+정맥급약조뇌혈관경련발생솔화3개월후예후불량솔[분별위25.0％ (5/20)비70.0％ (14/20)、55.0％ (11/20)、35.0％ (7/20)화30.0％ (6/20)비50.0％(10/20)、40.0％ (8/20)、35.0％ (7/20)]명현저우대조조、구복혹비사급약조、정맥급약조,차이균유통계학의의(균P＜0.05).술야관세+정맥급약조、정맥급약、구복혹비사급약조、대조조환자수술후1주、2주、3주Vp균교수술전저(균P＜0.05)；4조환자술후1주내로내압변화균수수종고봉기적변화정현선승고후하강적추세；술후4조환자GCS변화균정상승추세,수술후제21천,4조환자GCS평분균교수술후제1천명현승고,차이유통계학의의(균P＜0.05).술야관세+정맥급약조예후불량환자비례명현저우대조조화구복혹비사급약조[30.0％(6/20)비50.0％ (10/20)、40.0％ (8/20),P＜0.05].결론 재로뇌창상조기채용정맥급약연합술야관세적방식사용니막지평치료t-SAH가이감소뇌혈관경련적발생.
Objective To observe the therapeutic effect of different administration routes of nimodipine in treatment of cranio-cerebral trauma with subarachoid hemorrhage.Methods All 80 patients with cerebral injury complicated by subarachoid hemorrhage [ glasgow coma scale(GCS) 6-12] were randomly divided into control group,oral administration group( for 14 days),intravenous injection group( by micro-pump for 14 days) and perfused group( perfused in operation and then injected).Intracranial pressure,GCS and contraction peak flow velocity of middle cerebral artery were closely observed,and glasgow outcome scale (GOS),complication were measured 3 months later.Results The proportion of cerebral vasospasm[ 25.0 (5/20) vs 70.0％ (14/20),55.0％ (11/20),35.0％ (7/20) ] and the rate of unfavourable prognosis [ 30.0％ ( 6/20 ) vs 50.0％ ( 10/20 ),40.0％ ( 8/20 ),35.0％ (7/20) ] in perfused group were significantly lower than those in the other three groups( all P ＜ 0.05).The contraction peak flow velocity of middle cerebral artery at 1 week,2 week,3 week after operation in perfused group were less than those in the other three groups (all P ＜ 0.05).The intracranial pressure in one week after operation in four groups showed the trends of rising first,and then decreasing.At 21 th day after operation,compared to the first day postoperation,the GCS score in four groups increased( all P ＜ 0.05 ).The ratio of patients of unfavourahle prognosis in perfused group significantly less than those in control group and oral administration group[30.0％ (6/20) vs 50.0％ (10/20) 、40.0％ ( 8/20 ),P ＜ 0.05 ].Conclusion Nimodipine perfusing in operation can decrease the proportion of cerebral vasospasm and has a therapeuric effect on subarachoid hemorrhage in the early stage of craniocerebral trauma.
